Influencing Factors Of Cirrhosis With Esophageal And Gastric Fundus Variceal Bleeding And The Predictive Value Of Three Models For Rebleeding After Treatment

Objective:To explore the influencing factors of bleeding in patients with cirrhosis associated with esophageal and gastric fundus varices,and to evaluate the predictive value of MELD-Na model scoring system,MELD model scoring system and CTP scoring system for rebleeding after treatment.Methods:446 patients with esophageal and gastric fundus varices with cirrhosis were retrospectively analyzed and divided into bleeding group and non-bleeding group according to the presence or absence of bleeding of esophageal and gastric fundus varices.Clinical data including age,gender,etiology of cirrhosis,MELD-Na model score,MELD model score,CTP score,electronic gastroscopy results,blood routine,total bilirubin,ALT,AST,creatinine,serum sodium,coagulation function and other indexes were counted respectively.Then univariate analysis was performed,and multivariate analysis was performed on the above statistically significant indicators to determine the independent risk factors for esophageal and gastric varices rupture and bleeding in cirrhosis.At the same time,228 patients in the bleeding group were followed up for half a year and one year,and the re-bleeding situation was counted.According to the clinical data,MELD-Na model score,MELD model score and CTP score were calculated respectively.To evaluate the predictive value of MELD-Na model scoring system,MELD model scoring system and CTP scoring system for rebleeding after treatment of ruptured esophageal and gastric varices.Results:1.Univariate analysis showed MELD-Na model scoring system,MELD model scoring system,CTP score,hepatic encephalopathy,ascites,severity of esophageal and gastric varices,red sign of varicose veins,HGB,WBC,PLT,ALB,TBIL,CREA,Na,PT,INR,etiology.There was statistical difference between the bleeding group and the non-bleeding group(P<0.05),while there were no statistical differences in gender,age,ALT,AST and APTT.2.Multivariate Logistic regression analysis indicated that the degree of esophageal and gastric fundus varices,red sign,PT and PLT were independent risk factors forbleeding in patients with cirrhosis and esophageal and gastric fundus varices.3.In 228 patients with liver cirrhosis complicated with esophageal and gastric variceal hemorrhage,37 cases rebleeding within half a year after treatment,the rebleeding rate was 16.23%.The area under the curve of MELD-NA model was larger than that of MELD-NA model and CTP score,and the AUC was 0.778,0.723 and 0.604,respectively.Comparison between MELD model scoring system and CTP scoring system Z=3.354,P<0.001;Comparison between MELD-NA model scoring system and CTP scoring system Z=2.175,P=0.029;Comparison between MELD-NA model scoring system and MELD model Z=0.218,P=0.8274.Among 2228 cirrhosis patients with esophageal and gastric fundus variceal hemorrhage,68 cases had rebleeding within one year after treatment,and the rebleeding rate was 29.82%.The area under the curve predicted by MELD-NA model was larger than that by MELD-NA model and CTP score,and the AUC was 0.829,0.701 and 0.654,respectively.Comparison between MELD model scoring system and CTP score Z=1.462,P=0.144;Comparison between MELD-NA model scoring system and CTP score Z=2.435,P=0.015;Comparison between MELD-NA model and MELD model Z=0.552,P=0.581.Conclusion:1.According to the single factor analysis,MELD-Na model scoring system,MELD model scoring system,CTP scoring system,hepatic encephalopathy,ascites,severity of esophageal and gastric varicose veins,red sign of varicose veins,HGB,WBC,PLT,ALB,TBIL,CEEA,Na,PT,INR,etiology are risk factors for esophageal and gastric varicose veins bleeding in cirrhosis.2.Multivariate Logistic analysis suggested that the degree of esophageal and gastric fundus varices,red sign of esophageal and gastric fundus varices,prothrombin time and platelets under endoscopy were independent risk factors for esophageal and gastric fundus varices bleeding in cirrhosis.3.Among the three scoring systems,MELD-Na model scoring system is superior to CTP in predicting rebleeding within six months or one year,and MELD model scoring system is superior to CTP in predicting rebleeding within six months.4.MELD-Na model can improve the predictive value of prognosis in patients with esophageal and gastric fundus varices in cirrhosis,and is worthy of further promotion and application in the future.